Russell J Bodurtha, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Burlington, CT
NPI 1033629092 · NPPES record last updated Oct 4, 2017
Key facts
- NPI
- 1033629092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11630 (CT)
- Practice address
- 292 Spielman Hwy
Burlington, CT 06013-1727 - Phone
- (860) 404-2924
- Fax
- (860) 404-2933
- NPI assigned
- Oct 4, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11630 | CT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Physical Therapy | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11630 | CT | Yes |
Addresses
Primary practice location
292 Spielman Hwy
Burlington, CT 06013-1727
Mailing address
465 Wolcott Rd
Wolcott, CT 06716-2613
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All providers in Burlington, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.